My husband and I are thinking about trying to conceive. What should I be doing before I get pregnant?
The first few weeks of pregnancy are crucial in a child's development. However, many women do not realize they are pregnant until several weeks after conception. Planning ahead and taking care of yourself before becoming pregnant is the best thing you can do for and your baby.

Talk to your doctor about your plans to become pregnant and behaviors that will improve the chances of a successful pregnancy. Here are some questions to ask:

• Will my personal and family medical history affect my pregnancy?

• What about the medications I'm taking?

• Do I need any vaccinations?

• Am I eating the right foods?

• Do I need to take vitamins?

• How about exercising?

Eliminate your exposure to alcohol, cigarettes and second hand smoke, harsh chemicals, hot tubs and saunas and medications. A few prescription medications such as the acne drug Accutane, as well as megadoses of vitamin A, pose a birth defect risk. Consult your obstetrician to find out whether any medications or vitamins you've been taking may mean an increased risk of problems. Grandma was right when she said, "an ounce of prevention is worth a pound of cure." So take her advice and head to your obstetrician's office as soon as you plan to become pregnant.

What are the concerns that I should be aware of if I am having a baby later in life?
A growing number of women are waiting until later in life to have their first child. There are great benefits to having a baby when you are more mature, prepared and experienced. Nonetheless, there are some problems that increase in frequency as you get older.

An older mother may be at increased risk for miscarriage, birth defects and pregnancy complications such as high blood pressure, gestational diabetes and difficult labors. Although older moms do have some special concerns, every woman's situation is different. Your age is no guarantee that you'll experience any of these conditions.

If you're worried about your pregnancy, be open with your doctor and communicate how you're feeling. Be sure to see your doctor early-before you're pregnant, if possible. Your pregnancy has a better chance of success if you start with a preconception check-up, good prenatal care and give birth in a healthcare facility equipped to care for high-risk mothers and babies.

How long should I wait to become pregnant if I have miscarried?
Discuss the timing of your next pregnancy with your doctor. Generally, waiting from one menstrual cycle to three months is recommended before trying to conceive again. Taking time to heal both physically and emotionally after a miscarriage is important.

Miscarriage in the first trimester most often occurs because there is a problem with the pregnancy -- a genetic abnormality, a significant deformity or a maternal infection that makes it impossible for the fetus to continue growing. Most of the time, this is a one-time event that isn't likely to happen again. If you have had three or more miscarriages, your obstetrician may suggest further diagnostic testing to help determine the cause.

This can be a difficult time. Allow yourself to grieve for the loss of your baby, but don't blame yourself. A miscarriage is not your fault. Share your feelings with your partner and with close family members. Pregnancy loss support groups may also be a valuable resource to you and your partner.

I have been trying to become pregnant for a year now and have been unsuccessful. When should I start to worry about the possibility of infertility?
Infertility is defined as a couple's inability to become pregnant after one year of trying without using birth control. When considering whether you may have an infertility problem, however, bear in mind that "normal fertility" is defined as the ability to naturally conceive within two years' time.

Fertility testing can begin at home. By using fertility awareness and basal body temperature readings, you can identify your fertile ovulation period. Some couples find that they simply have been missing their most fertile days when trying to conceive.

Consider medical testing for a cause of infertility if you have noticed an absence of ejaculation or ovulation, menstruation irregularities or have a history of miscarriages or pelvic inflammatory disease. Talk with your doctor if you are in your mid-30s or older, and have been unable to conceive for 6 months or are in your 20s to early 30s and have been unable to conceive for a year or more.

Initial testing for a couple's cause of infertility evaluates both partners' health and habits, his semen, and her ability to ovulate. If no cause is found, further testing can be done. Infertility treatment ranges from simple home treatment to specialized surgical, hormonal, and assisted reproductive technology treatments. Talk with your doctor about options available to you.

What are the recommendations for exercise during each stage of my pregnancy?
One of the best things you can do for your baby during pregnancy is to take good care of yourself - including reasonable exercise. If you have been in a regular exercise program, you may continue that activity with your doctor's permission. Be sure to ask what modifications are necessary as your pregnancy progresses. If you have not exercised at all prior to your pregnancy, get your doctor's permission and begin slowly.

Many general exercise guidelines hold true for pregnant moms as well. Set a goal of exercising three to four times per week, keep yourself well hydrated and do not exercise to the point of exhaustion, pain, light-headedness, nausea or headache. Remember to warm-up and stretch before exercising and cool-down and stretch afterwards.

Special considerations for pregnant women include:

• Reduce the intensity of your workout during the third trimester

• Avoid saunas, steam rooms and hot tubs

• After the fourth month, don't exercise flat on your back

• Avoid pointing your toes, sit-ups and sudden jolting movements

• Mother's heart rate should stay below 140 beats per minute

• Mother's core temperature should not exceed 100 Fahrenheit

• Heavy weight lifting should be avoided.

What about the risk of second-hand smoke?
If you are around people who smoke, your baby receives almost as much cigarette smoke and its harmful by-products as if you were smoking. Unborn babies have been found to have nicotine in their fingernails and hair while still in the uterus.

Smoking during your pregnancy, as well as second hand smoke, increases the risks of miscarriage, bleeding early in the first trimester and separation of the placenta. It has a negative effect on your respiratory and circulatory system and may place your child at greater risk of respiratory problems throughout childhood. In addition it can lower birth weight and Apgar scores, increase the risk of crib death and have long term physical and intellectual impact. If you have family members or co-workers who smoke, ask that they not smoke when they are in the same room with you. Explaining the risks to your baby will probably be all the motivation they need to be considerate.

What types of food and drink (caffeine, chocolate, etc.) should I stay away from when I am pregnant?
Caffeine is a mild stimulant, found in coffee, tea, many soft drinks, chocolate and some non-prescription medications like pain-relievers and cold remedies. While it does reach your unborn baby, moderate use of up to three cups of coffee in 24 hours appears to have no negative consequences.

Despite this reassurance, you may want to decrease or eliminate your consumption of caffeine during pregnancy. It offers no nutritional value but may have some effects you don't like. Caffeine has a diuretic effect, drawing fluid and calcium from your body; it increases the frequency of urination; may contribute to feelings of nervousness or jitteriness; and may interfere with your ability to rest.

Keep high-sugar and high-fat foods to a minimum. High sugar foods pile on calories while providing almost no nutrient value to you or your baby. Eliminate the use of alcohol. Also, now is a good time to quit smoking because of the risks it creates for your baby.

How does the stress level at my job affect a healthy pregnancy?
According to the March of Dimes, very high levels of stress may contribute to preterm birth or low birth weight in full-term babies.

Stress is a normal part of life. Identifying the situations that cause you stress are the first steps in helping reduce it. Schedule time and activities that help you relax. Exercise, meditation, massage therapy, deep breathing exercises, even reading a book or listening to soothing music can be relaxing.

Take good care of yourself. Eat regularly and nutritiously, drink lots of water, get plenty of rest, avoid alcohol, cigarette smoking, herbal products or drugs. Stay away from stressful people and stressful situations, when possible. Talk-to your partner, friends, relatives and health care professionals. If you feel overwhelmed, talk with a trained counselor or other mental health professional.

As with all aspects of your pregnancy, going to all your prenatal care appointments is important. This will give you the reassurance that everything is okay with your baby or let your health care provider know about a problem while there is still time to do something about it. You'll feel less stressed because you know you are doing the best for your baby.

How much weight should I expect to gain during each stage of my pregnancy?
It is important to keep in mind the phenomenal growth your baby is experiencing during these crucial nine months. This is no time to short-change your baby's nutritional needs!

However, gaining too much weight during pregnancy can lead to discomfort and health risks. Today, doctors usually recommend a weight gain of 20-35 pounds during pregnancy. Included with this recommendation is the advice to consume about 2000-2500 calories each day. Your doctor can make recommendations to you based on your individual medical situation.

If you are concerned about weight gain, select your food choices wisely and talk to your doctor. You can meet your protein needs with six tablespoons of peanut butter (600 calories) or with 3.5 ounces of water packed tuna (125 calories). Read labels to help you choose food high in protein while lower in caloric and fat content. Aim for variety in your diet. The best way to have a healthy pregnancy weight gain is to be sure you get plenty of protein, try lots of different kinds of fruits, vegetables and grains fruits, limit fat intake, and get regular moderate exercise.

What month should I start pre-natal care?
As soon as you discover you are pregnant.

Choosing a good obstetrician/gynecologist (Ob/Gyn), who has specialized training in the care of women during pregnancy, labor, and delivery, is an important step in your pregnancy.

The goal of prenatal care is to help insure a healthy pregnancy for both you and your baby. During a typical visit your doctor will check your weight, blood pressure, urine and talk with you to identify any problems or discomforts you may be feeling. In addition, your doctor will monitor the growth and development of the baby and listen to your baby's heart rate. Counseling and guidance are provided about weight gain, exercise, nutrition, vitamins and overall health.

Prenatal exams are usually scheduled every month from the 1st week through the 28th week of your pregnancy, every two weeks through the 36th week and weekly from the 37th week until delivery.

What if I was unaware that I was pregnant and consumed alcohol? Can this harm the baby?
While the risks of having a few drinks early in the pregnancy prior to knowing you are pregnant are probably not significant, now that you know you are pregnant, protect your baby from the harmful effects of alcohol.

The risks of alcohol consumption are dose-related; the more you drink the greater the risk to your baby. Alcohol enters the fetal bloodstream in approximately the same concentrations present in mother's blood. Therefore, each drink a pregnant woman takes is shared with her tiny baby, who has an immature liver and is less able to detoxify alcohol than a mature adult.

If you consider yourself to be a heavy drinker and have difficulty giving up alcohol, discuss this with your doctor. Consider getting help through alcohol treatment programs or Alcoholics Anonymous.

What are my pain relief options during labor besides an epidural?
One of the things I recommend for all my patients is to attend a childbirth preparation class. Mercy's classes help you learn how to handle the sensations of labor and delivery and to remain in control of your childbirth. You will learn about conscious relaxation, visual concentration, breathing techniques, pre-natal exercise and understanding the coach's role.

Talk to your doctor in advance about pain management options available once labor begins. Epidural anesthesia has gained popularity because the majority of women obtain superior to total relief of labor pain as compared to that achieved through narcotics. Demoral or Stadol are narcotics that can be given to take the edge off the pain, helping you to relax, but they do not alleviate all pain. A saddle block provides total pain relief for delivery, but can be given only late in labor. Local blocks can be provided for good perineal pain relief for cutting and repair of the episiotomy.

Should I take pre-natal vitamins before I become pregnant? What supplements should I take during my pregnancy?
Although everyone agrees you should turn to nutritious foods first to meet your vitamin and mineral needs, the reality is that many women's diets fall short of the ideal. A good vitamin supplement can fill in the nutritional gaps on those days when you don't eat quite right. For your health, and the health of your baby, prenatal vitamins make up for any nutritional deficiencies in your diet during pregnancy. While the supplements contain numerous vitamins and minerals, their folic acid, iron, and calcium content are especially important.

A multiple vitamin and mineral supplement supplies about 100 percent of the Recommended Dietary Allowances and is sufficient for most adults. However, during pregnancy, iron, calcium, and folic acid are required at higher levels.

Pregnancy isn't the time to experiment with large doses of single nutrients, since megadoses of some of them-such as vitamin A, vitamin D, selenium, and fluoride-can produce side effects ranging from mottled teeth to birth defects. Always consult your physician before taking any supplement during pregnancy.

And finally, remember you and your baby need a well-balanced diet, including 13 essential vitamins. Aim for variety in your diet and include a variety of fruits and vegetables, animal products and an assortment of whole grain breads and fortified cereals.

What are the best ways to involve my husband during my pregnancy?
Your pregnancy may not seem fully real to your partner until you begin to show, or he feels the baby kick or sees his baby on ultrasound. But at some point, the upcoming birth of his baby will become very real to him.

While most dads anticipate the birth of their baby with lots of joy, they may also begin to feel the weight of additional financial responsibilities, wonder if they will be a good parent, and worry about the baby's and your health. Sometimes he may even be a little jealous that he is no longer the center of your attention.

Be sure to talk to each other about what's on your minds. Make decisions together about when to tell relatives about your pregnancy. Arrange for Dad to go with you to the doctor appointments and to all of the childbirth classes. Encourage him to talk with other expectant or new dads about their experiences. And since many men like to "fix" things, work together in preparing your home for the new baby by safety proofing it from wall to wall and getting the baby's room ready.

Pregnancy is a time of "growing" and preparing for both of you. It can be a time for your relationship to deepen as you grow from a couple into a family.

How does an irregular period affect my chances of conceiving?
Irregular or abnormal ovulation and menstruation accounts for 30% to 40% of all cases of infertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren't ovulating, a condition known clinically as anovulation.

Although anovulation can usually be treated with fertility drugs, it is important to rule out other conditions that could interfere with ovulation, such as liver disease, diabetes, problems with the ovaries, and abnormalities of the adrenal, pituitary, or thyroid glands, which produce important hormones.

What substances (household chemicals, x-rays, etc.) should I avoid during my pregnancy?
Good common sense and some caution will go a long way in this area. During your pregnancy avoid breathing such things as insecticides, paint fumes, oven cleaner or rooms filled with cigarette smoke. If you think you may be exposed to hazardous materials in your work place, check with your employer for additional information and safety precautions that can be taken.

Avoid being around people with any illnesses - colds, sore throat, flu or diarrhea. If you do become ill, check with your doctor before taking any over the counter medications. Do not take aspirin during the third trimester of your pregnancy.

While more research is needed to determine whether exposure to microwaves is harmful to unborn babies, the possibility exists, so take precautions. Be sure your microwave doesn't leak and stand away from the oven door when it is in operation.

In addition, although X-rays today are very low dose, it would be wise to minimize your exposure.

And remember to stay away from the cat's litter pan. You may already be immune to an infection called toxoplasmosis that is spread by cats that can cause serious problems for your unborn child. Toxoplasmosis is also caused by raw or undercooked meat.

What can I do to help avoid or ease morning sickness?
About half of all pregnant women have morning sickness, or nausea, in the first trimester. Your symptoms may be most severe in the morning, but can occur at any time during the day. The cause of morning sickness may be due to the changes in hormone levels during pregnancy and seem to be aggravated by stress, traveling and certain foods high in protein and fat.

A few strategies that help include:

• Eat a few crackers or a rice cake before getting out of bed in the morning.

• Eat a diet high in protein and carbohydrates

• Drink plenty of fluids to maintain your hydration and limit caffeine which can contribute to dehydration

• Eat small snacks frequently to avoid excessive hunger or eat small meals several times a day

• Avoid the sight, smell, and taste of foods that make you feel queasy. These are often high fat foods like bacon or pepperoni.

• Do not take any anti-nausea medication without checking with your doctor.

Many women also feel an overwhelming sleepiness during early pregnancy. Give in to the urge to sleep if you can. Go to bed earlier or take naps, but be assured that for most women the morning sickness and sleepiness go away after the first trimester.

What are the precautions that I can take to avoid stretch marks?
Many women experience red or pink streaks that appear on the abdomen, hips and breasts. These marks, which are caused by hormonal changes and stretching skin, may become more noticeable after delivery. Unfortunately, they tend to be permanent and there is little that can be done to prevent them from occurring.

Although they may never disappear completely, they will fade considerably over time. While many women purchase special creams, lotions and oils to help prevent and erase stretch marks, there is little evidence that they work. Whether you are prone to stretch marks depends a great deal on your skin's natural elasticity. About half of women develop stretch marks during pregnancy, regardless of whether or not they have used any topical ointments.

Here's what you can do to help minimize those marks: stay within your weight-gain guidelines, eat foods high in vitamins A, D and E to nourish your skin from the inside and help keep it supple, rub a little lotion on your stomach to keep the skin soft.

What tests should I expect to be performed on me during my pregnancy?
Prenatal testing generally begins with your first doctor visit and continues throughout your pregnancy. Initial blood tests may include your blood type antibody screening, rubella status, hepatitis B surface antigen and thyroid testing. Urine tests may be done to screen for infection. During your subsequent visits, you will have your weight and blood pressure taken, and your urine tested for sugar and protein. You will be checked periodically for anemia.

Specialized tests will be ordered if indicated by your medical history or your current condition. An ultrasound test may be ordered during the second or third trimester to confirm your baby's age, the baby's growth and the baby's position in the uterus. You will be offered blood triple screening at 16 weeks of pregnancy for down’s syndrome and neural tube defect. Sometime in the late 2nd trimester you will be tested for gestational diabetes.

In the last month of your pregnancy, there are some optional tests that may be performed if your doctor feels they are necessary. An NST (nonstress test) may be ordered if there is a decrease in fetal movement or other concerns with the baby. Group B strep testing is done at the beginning of the ninth month to see whether you are a carrier.

Concern about your baby's health is completely normal, so talk with your doctor about your worries. Your doctor can provide you with a great deal of reassurance as your pregnancy progresses and you continue to do all that you can to keep your baby healthy.
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How will I know when I'm in labor?
This is probably the most common question expectant moms ask. You will learn all about the signs of labor in your childbirth class, but here is a quick review. The signs of pre-labor can precede labor by days or weeks. Signs of real labor include:

• Contractions become more intense with activity

• Contractions aren't relieved by a change in position

• Pain begins in the lower back and spreads to the lower abdomen

• Pain may radiate to the legs

• Contractions may feel like stomach cramps and may be accompanied by diarrhea

• Contractions become more frequent and more painful

• Contractions become more regular, about five minutes apart lasting 45-60 seconds

• Membranes rupture

• "Show" is present and is pinkish or blood-streaked